Parkland Health led the nation in emergency room visits in 2021, according to research from prescription advocacy service NiceRX and Becker’s Hospital Review. In 2021, Dallas County’s public hospital reported 210,152 emergency room visits.
According to self-reported numbers, North Texas had several hospitals on the list of top emergency room visits in the country. Parkland took the top spot, Texas Health Harris Methodist Fort Worth was No. 6 with 144,330 visits, JPS Health Network was No. 14 with 117,956, and Children’s Medical Center Dallas was No. 24 on the list with 104,078 visits in 2021.
Parkland is no stranger to setting records for capacity. In 2001, the hospital set a national record when it delivered 16,597 babies in one year. Nearly a year ago, the omicron variant caused a spike in COVID-19 cases, contributing to Parkland Health’s setting a record in single-day emergency room visits. On December 27 last year, 995 people checked into the hospital’s emergency department. On Tuesday, 910 showed up, and the following day noted 870 check-ins, according to NBCDFW.
The hospital was recently ranked by Washington Monthly as one of the top health systems for the people, meaning it is accessible and has high outcomes. Parkland was also named “high performing” by U.S. News and World Report for maternity. However, it received a “D” in Leapfrog’s latest safety ranking (Parkland does not submit voluntary data to Leapfrog).
Parkland is Dallas County’s safety net hospital, meaning it will treat uninsured, indigent, and undocumented patients without question. According to Parkland, 33 percent of the care provided at Parkland is charity care, meaning medical services for which it doesn’t receive any payment. For reference, 8 percent of the care provided by Baylor University Medical Center is charity care according to Sage, and Medical City Dallas provides 6 percent. More than a quarter of Parkland’s care is paid for by Medicaid, and only 8 percent of payers have commercial insurance, which typically has higher reimbursement rates than Medicare and Medicaid.
So what does a busy Parkland Health mean for our community? Many patients in Parkland’s emergency room are not suffering from emergencies but cannot pay for healthcare elsewhere and know that Parkland will help them. Without health insurance, the emergency room is often the only option for those without the cash to pay for a doctor’s visit. That means many problems better suited for a primary care physician’s office or even urgent care end up in Parkland’s emergency department.
The hospital provides a significant percentage of charity care while being the busiest in the country, meaning the payment structure looks different at Parkland (and JPS) than most other hospitals. If it isn’t from a government or private payer, those funds must be found somewhere. The physicians, nurses, techs, cafeteria workers, maintenance people, and other positions still have to be paid for the services provided to patients who cannot pay.
Much of those funds come from Dallas County taxpayers. The more people who show up at Parkland and cannot pay, the more tax dollars are needed to pay for the hospital’s operation. In theory, these tax dollars could go to other needs like roads and law enforcement. Why does Parkland provide so much charity care? Texas leads the nation in uninsured rate and has more uninsured residents than any other state, and Dallas has one of the highest uninsured rates of any large city in the country. High rates of uninsured patients mean the hospital is providing massive amounts of services without getting any payment. The fact that they don’t have insurance means they aren’t getting regular care and only show up to the hospital emergency department when their medical issue has become unbearable – and expensive.
Texas is one of the few states that has yet to expand Medicaid and insure around one million working Texans. This would give the state access to additional federal funding to ameliorate some of the costly charity care Parkland and other hospitals provide. Research shows it is a money-maker for the state because preventative care would decrease the number of medical issues that were only treated when they were in later stages and more expensive.
In its newest iteration, Parkland Health is a model for efficiency and capacity. Still, in Texas, quality care at safety net hospitals is often more expensive than it would be if more Texans had access to preventative care.